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Patient authorization for release of medical ... - Penn State Health 2026
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How to use or fill out patient authorization for release of medical records - Penn State Health
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the Patient Information section. Enter your name, date of birth, medical record number, phone number, and email address.
- In the Reason for Request section, select the appropriate option that describes why you are requesting the information.
- Authorize a specific employee or agent by writing their name in the designated field and check the relevant options regarding what healthcare information can be discussed.
- Complete the Addressee Field with the name and address of the person or entity to whom you want to release or receive information.
- Choose your preferred format for receiving medical information from the options provided.
- Specify which types of medical records you are requesting by checking the appropriate boxes and listing their dates of service.
- Sign and date the form at the bottom. If someone else is signing on your behalf, indicate their relationship to you.
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What is an authorization for release of protected patient health information?
To respect HIPAA compliance rules, a signed HIPAA release form must be obtained from a patient before their protected health information can be shared with other individuals or organizations, except in the case of routine disclosures for treatment, payment or healthcare operations permitted by the HIPAA Privacy Rule.
How to send medical records via fax?
The easiest way to access your electronic medical records is through our secure website for patient tools and information, My Penn State Hershey Health. This site gives you access to your medical records and test results, where you can print a copy for your needs.
How to get medical records from Hershey medical Center?
Temple University Hospital Patients Phone: 215-707-3755. Fax: 215-707-6123.
What is the fax number for Hershey medical Center medical records?
Using Traditional Fax Machines to Fax Medical Records Create a confidential fax cover letter and print it out. Print the medical records. Enter the receiving fax phone number into your fax machine. Feed the fax documents into the machine, starting with the cover sheet. Send the fax.
What is the fax number for Milton S Hershey Medical Center medical records?
Hershey Medical Center and Penn State Medical Group providers. If you are working to obtain patient records on an individual who was not referred by you to the Penn State Health system, please fax these requests (on your official organizational letterhead) for the specific patient information to 717-531-5068.
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At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.
People also ask
How to obtain medical records in Pennsylvania?
Contact the state department of health: docHub out to the Pennsylvania Department of Health by calling 877.774. 4748 or emailing pasiis@state.pa.us. Any records for vaccines given in Philadelphia must be obtained by contacting 215.685.
Does Hershey Medical Center have a patient portal?
My Health Patient Portal A patient will use this portal, if you have been hospitalized at Hampden Medical Center, Holy Spirit Medical Center, Lancaster Medical Center, Milton S. Hershey Medical Center or St. Joseph Medical Center.
Related links
l For requesting this patients medical information or images to be sent from another facility to Penn State Health l For a Penn State Health employee/agentRead more
Our project was created with the intention to help people. To achieve this, it is imperative that we communicate with the people our project would effect.Read more